Assessing the accuracy of the International Classification of Diseases codes to identify abusive head trauma: a
Rachel P Berger1, Sharyn Parks2, Janet Fromkin1
1Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA.
Insights
An International Classification of Diseases (ICD) code-based definition accurately identifies abusive head trauma (AHT) in children. This study found high sensitivity and specificity, suggesting its utility in clinical settings.
Area of Science:
- Medical Informatics
- Paediatric Medicine
- Forensic Medicine
Background:
- Abusive head trauma (AHT) is a significant cause of paediatric injury.
- Accurate case identification is crucial for timely intervention and child protection.
- International Classification of Diseases (ICD) codes are widely used for medical record data abstraction.
Purpose of the Study:
- To evaluate the diagnostic accuracy of an ICD code-based operational case definition for AHT.
- To determine the sensitivity and specificity of this definition in a paediatric tertiary care setting.
Main Methods:
- Children under 5 years evaluated for AHT by a Child Protection Team (CPT) were included.
- Cases were classified as AHT or non-AHT traumatic brain injury (TBI) based on CPT determination.
- Sensitivity and specificity of the ICD-based definition were calculated using CPT findings as the reference standard.
Main Results:
- The ICD-based definition demonstrated high accuracy with 92% sensitivity and 96% specificity.
- Most classification errors were attributed to medical coders, with one physician error noted.
- The study included 223 children, with 117 confirmed AHT cases and 106 non-AHT TBI cases.
Conclusions:
- The ICD-based operational case definition for AHT is highly accurate in a paediatric tertiary care hospital with an electronic medical record system.
- Further research is necessary to validate this definition across diverse healthcare settings.
- The findings support the use of ICD codes for identifying AHT cases, with attention to coder accuracy.
Objective:
To assess the accuracy of an International Classification of Diseases (ICD) code-based operational case definition for abusive head trauma (AHT).
Methods:
Subjects were children <5 years of age evaluated for AHT by a hospital-based Child Protection Team (CPT) at a tertiary care paediatric hospital with a completely electronic medical record (EMR) system. Subjects were designated as non-AHT traumatic brain injury (TBI) or AHT based on whether the CPT determined that the injuries were due to AHT. The sensitivity and specificity of the ICD-based definition were calculated.
Results:
There were 223 children evaluated for AHT: 117 AHT and 106 non-AHT TBI. The sensitivity and specificity of the ICD-based operational case definition were 92% (95% CI 85.8 to 96.2) and 96% (95% CI 92.3 to 99.7), respectively. All errors in sensitivity and three of the four specificity errors were due to coder error; one specificity error was a physician error.
Conclusions:
In a paediatric tertiary care hospital with an EMR system, the accuracy of an ICD-based case definition for AHT was high. Additional studies are needed to assess the accuracy of this definition in all types of hospitals in which children with AHT are cared for.
